10 Warning Signs of the Inflammatory Bowel Disease

The symptoms of ulcerative colitis – abdominal pain, bloody diarrhea, weight loss – are the same as those of many other ailments. In fact, this inflammatory bowel disease is often confused with Crohn’s disease, the other major IBD. How can you tell when it’s really UC? Read on for the red flags to watch for ulcerative colitis...

Suffering from cramps, belly pain and bloody diarrhea?

You could have ulcerative colitis (UC), an autoimmune inflammatory bowel disease.

“If you ate a chicken sandwich and four hours later you got abdominal pain, we can be pretty sure it’s food poisoning,” says Cuckoo Choudhary, MD, a gastroenterologist at Jefferson University Hospital in Philadelphia.

Doctors will likely ask: “Where does it hurt”?

“If the pain is in the right upper quadrant, it could be gall bladder disease,” says Lisa Liu, MD, a family practice physician with Gottlieb Memorial Hospital, part of Loyola University Health System outside Chicago.

“If it’s in the left upper quadrant, it could be pancreatitis [inflammation of the pancreas]. If there’s pain between the rib cages, it could be gastroesophageal reflux disease (GERD). If the pain is above the bladder, it could be a urinary tract infection,” she says.

And if it’s in the right lower quadrant?

“It could be Crohn’s disease, UC or appendicitis,” she says.

Red flags for ulcerative colitis:

“If you have abdominal pain and tenderness on the right side of the lower abdomen that persists over several months and comes and goes, that’s a telltale sign of ulcerative colitis,” says Feza Remzi, MD, chairman of the department of colorectal surgery at the Digestive Disease Institute of the Cleveland Clinic.

More clues:

“A feeling of fullness in the lower right abdomen is another classic sign,” he says.

“If you have bloody diarrhea and blood in the stools, we suspect UC,” Dr. Choudhary says.

“With UC, the pain isn’t relieved after you have a bowel movement,” says Mamoon Raza, MD, a gastroenterologist with Elkhart General Hospital in Indiana.

“If you feel like you have to move your bowels but you can’t, that could be UC,” Dr. Liu says.

2. Bloody diarrhea

“Bloody diarrhea can be caused by an infection like salmonella or E. coli, it could be a symptom of Crohn’s disease or colon cancer, or it could signal a different type of colitis, such as hemorrhagic colitis [usually caused by E. coli] or ischemtic colitis [which develops when blood flow to a part of your large intestine is reduced],” Dr. Raza says.

Another cause of bloody diarrhea is infectious colitis or diverticulitis, which occurs when diverticula [pouch-like bulges] develop in the digestive tract and become inflamed or infected, he says.

Hemorrhoids may also cause slight bleeding, but usually not the profuse bleeding seen in UC, he adds.

Red flags for ulcerative colitis:

“If you have urgent bloody diarrhea that occurs in the absence of eating or even in the middle of the night when you’re asleep, it’s probably UC,” Dr. Raza says.

“Because the rectum is inflamed in ulcerative colitis, there’s a sense of urgency even when you have little to evacuate,” he says.

More clues:

You have abdominal pain and a low-grade fever, he says.

The diarrhea doesn’t go away. “With UC, the diarrhea is chronic and comes and goes over a period of months,” he says.

“When we’re looking at a nonspecific symptom like weight loss, we have to take the whole picture into consideration, including a woman’s age, her family history, and whether she has other conditions that may cause weight loss,” Dr. Liu says.

Another clue: The weight loss is gradual rather than sudden and occurs over a few months, Dr. Raza says.

4. Back and joint pain

Did you overdo it at the gym? Or maybe your achy fingers are an early sign of arthritis?

“Most people don’t associate back and joint pain with UC, but both are common symptoms of a UC flare-up,” Dr. Raza says.

Back pain is also a symptom of pancreatitis, kidney stones, rheumatoid arthritis, lupus and infectious diseases such as Epstein-Barr, hepatitis, influenza, Lyme disease, measles, mumps, German measles and chicken pox, he says.

Red flags for ulcerative colitis:

“The joint pain in UC is usually in the large joints of the knees and elbows,” Dr. Choudhary says.

More clues:

When you have back pain with arthritis or an injury, you usually don’t have intestinal symptoms, such as abdominal pain and bloody diarrhea, Dr. Raza says. With UC, you do have those classic symptoms.

Did you feel worse after taking a nonsteroidal anti-inflammatory drug (NSAID) such as Advil, Motrin and Celebrex? It could be UC. NSAIDs are known triggers for UC and cause symptoms to flare, Dr. Bhatia says.

5. Anemia/fatigue

Anemia occurs in UC when you lose blood (through chronic bloody diarrhea) and can’t produce enough new blood cells. Over time, the blood loss can lead to iron and other nutritional deficiencies and cause fatigue, Dr. Liu says.

But anemia is also seen in many other diseases, such as Crohn’s disease, colon cancer, kidney disease, inherited blood diseases like sickle cell anemia, autoimmune diseases such as lupus and rheumatoid arthritis, and viral infections, Dr. Choudhary says.

Red flags for ulcerative colitis:

“Anemia that occurs in combination with bloody diarrhea and abdominal pain is usually UC,” Dr. Raza says.

About 10% of people with ulcerative colitis develop two specific eye diseases, she says.

These eye conditions can also affect women with other autoimmune disorders, such as rheumatoid arthritis and Crohn’s disease, and can also be caused by infection or exposure to toxins like household chemicals, Dr. Harris says.

Red flags for ulcerative colitis:

Your eye problems are accompanied by classic UC symptoms.

More clues:

You have uveitis, a swelling and irritation of the uvea, or the middle layer of the eye, Dr. Harris says. Symptoms include blurred vision; dark, floating spots in the vision; eye pain; redness and sensitivity to light.

Or you have episcleritis, an irritation and inflammation of the episclera, the thin layer of tissue covering the white part (sclera) of the eye, she says. Symptoms include a pinkish color in the sclera, eye pain and tenderness and sensitivity to light.

7. Unusual skin rashes

“Many things can cause a rash, from chemicals in latex and cosmetics to allergic reactions to plants like poison oak and poison ivy, medications and insect bites,” says William Calhoun, MD, vice chair for research, department of internal medicine, at the University of Texas Medical Branch in Galveston, Texas.

“Two specific skin lesions are associated with UC – but they aren’t common,” Dr. Harris says. “While about 70% of people with these skin rashes have UC, only about 5%-10% of people with UC have them,” she says.

Red flags for ulcerative colitis:

“If your rash occurs with abdominal pain and bloody diarrhea, it could be a symptom of UC,” she says.

More clues:

You have pyoderma gangrenosum, a skin condition that causes painful deep sores (ulcers), Dr. Harris says. The disease often occurs on the legs, but it can occur elsewhere, including internal organs.

Or you have erythema nodosum, a skin condition that appears as painful red nodules on the front of the legs below the knees or on your arms, she says.

8. Rapid heartbeat

A rapid heartbeat, also called tachycardia, is a condition in which the heart beats more than 100 times per minute.

“A racing heart can be caused by many diseases and conditions, such as hyperthyroidism, congenital heart defects and even by dehydration, which is caused by the chronic diarrhea in UC,” Dr. Liu says.

Red flags for ulcerative colitis:

“You have a racing heart in combination with other UC symptoms — abdominal pain, bloody diarrhea and cramping,” she says.

9. Fever

A fever is your body’s way of flushing out an infection, whether it’s the flu, a cold, an ear or sinus infection or even a urinary tract infection, Dr. Liu says.

“It’s a low-grade fever [a fever that raises the body’s temperature by just a degree or two] rather than a high fever,” she says.

10. Depression and anxiety

“It’s not uncommon to see depression in women who have ulcerative colitis, even if they haven’t yet been diagnosed with the disease,” Dr. Raza says.

That’s because they feel afraid or embarrassed to leave the house, especially if they aren’t sure where the next restroom is, Dr. Raza says. The diarrhea in UC occurs suddenly and can be involuntary and even occur when you’re asleep, he says.

This makes it difficult for a woman to go to work, enjoy social functions or live a normal life, leading to feelings of isolation and frustration, he says.

Red flags for ulcerative colitis:

If you’re depressed and you also have bloody diarrhea, cramping and abdominal pain, it could be UC, Dr. Raza says.

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